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    Mitigating Risks in Lumbar Sympathetic Blocks

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    Evento adverso en bloqueo simpático lumbar

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    Mitigating Risks in Lumbar Sympathetic Blocks

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    cabeto.ordonez
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    Evento adverso en bloqueo simpático lumbar

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    Evento adverso en bloqueo simpático lumbar

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    10 views2 pages

    Mitigating Risks in Lumbar Sympathetic Blocks

    Uploaded by

    cabeto.ordonez
    Evento adverso en bloqueo simpático lumbar

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    TEACHING IMAGES: MITIGATING RISKS IN LUMBAR SYMPHATHETIC

    BLOCK

    Authors: Juan Felipe Vargas Silva, MD Pain Medicine, FIPP 1; Juan Sebastian
    Infante Martínez, MD Pain Medicine, FIPP 1; Eladio Pérez Maldonado, MD
    Palliative and Pain Medicine2 David Tadeo Carrillo Rangel, MD Fellow in Palliative
    and Pain Medicine2; David Leonardo Mantilla Borda, MD Pain Medicine 3; Carlos
    Alberto Ordoñez Martínez; Palliative and Pain Medicine3
    From:
    1
    Department of Pain Clinic, Hospital Pablo Tobón Uribe, Medellín, Colombia;
    2
    Instituto Jalisciense de Alivio al Dolor y Cuidados Paliativos PALIA; 3El Bosque
    University Department of Pain Clinic, Hospital Pablo Tobon Uribe, Medellín,
    Colombia; 3Department of Palliative and Pain Medicine, Hospital General de
    Occidente, Zapopan, México

    Corresponding author: Juan Felipe Vargas Silva MD Pain Medicine, FIPP, email:
    [email protected], Telephone number: +57 604 4455167
    Presenting author: David Tadeo Carrillo Rangel, MD Fellow in Palliative and Pain
    Medicine

    Introduction
    Lumbar sympathetic block (LSB) is an interventional procedure commonly used for
    the diagnosis and treatment of various lower-extremity pain conditions. Although
    considered safe, LSB can cause genitofemoral neuralgia if neurolytic solutions are
    inadvertently injected into the psoas muscle.
    Methodology
    During a lumbar sympathetic neurolysis in a patient with peripheral arterial disease,
    contrast medium administration indicated a linear, band-like spread, suggesting
    psoas muscle injection (Figure 1). Following this, Needle advancement under
    fluoroscopy was confirmed with contrast medium showing adequate diffusion
    (Figure 2). The procedure concluded without complications or adverse events.
    Discussion
    Hong et al. (2010) conducted a prospective study on the incidence of contrast
    injection in the psoas muscle during LSB at L2, L3, and L4 vertebral levels. The
    genitofemoral nerve proximity to the lumbar sympathetic trunk, especially at L3 and
    L4, likely explains the higher occurrence of genitofemoral neuralgia following
    neurolytic injection at this level. Pennekamp et al. (2013) documented a case of
    permanent lateral femoral cutaneous nerve injury post-lumbar sympathetic block,
    attributing the damage to the diffusion of the neurolytic agent along the psoas
    muscle.
    While generally not severe, contrast injection into the psoas muscle can cause
    discomfort. Furthermore, administering neurolytic solutions into the psoas muscle
    may lead to genitofemoral neuralgia, resulting in pain in the groin and inner thigh.
    Conclusion
    Although lumbar sympathetic block is generally safe, physicians must be aware of
    potential risks and take precautions to mitigate them.

    References:
    1. Vargas Silva, J.F., Peng, P. (2022). Lumbar Sympathetic Block. In: Jankovic,
    D., Peng, P. (eds) Regional Nerve Blocks in Anesthesia and Pain Therapy.
    Springer, Cham.

    2. Feigl, G. C., Dreu, M., Ulz, H., Breschan, C., Maier, C., & Likar, R. (2014).
    Susceptibility of the genitofemoral and lateral femoral cutaneous nerves to
    complications from lumbar sympathetic blocks: Is there a morphological
    reason?. British Journal of Anaesthesia, 112(6), 1098-1104.

    3. Hong, J. H., Kim, A. R., Lee, M. Y., Kim, Y. C., & Oh, M. J. (2010). A
    prospective evaluation of psoas muscle and intravascular injection in lumbar
    sympathetic ganglion block. Anesthesia and Analgesia, 111(3), 802-807.

    4. Pennekamp, W., Krumova, E. K., Feigl, G. P., Frombach, E., Nicolas, V.,
    Schwarzer, A., & Maier, C. (2013). Permanent lesion of the lateral femoral
    cutaneous nerve after low-volume ethanol 96% application on the lumbar
    sympathetic chain. Pain Physician, 16(4), 391-397.

    5. Kaya, S. S., Celik, S., Akcaboy, E. Y., Goksu, H., Ayhan, M. Y., & Sahin, S.
    (2022). Effect of the lumbar sympathetic block on pain in patients with
    symptomatic peripheral arterial disease-retrospective analysis. Journal of
    Anesthesia, Reanimation and Critical Care Medicine, 30(3), 188-192.

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